Chronic Lymphocytic Leukemia

Chronic Lymphocytic Leukemia is a type of cancer where the bone marrow makes too many lymphocytes; a type of white blood cell. The white blood cells fight infection and disease. Chronic Lymphocytic Leukemia is sometimes called (CLL) and is a blood and bone marrow disease that usually gets worse slowly.

It is the most common type of leukemia in adults. Sometimes it often occurs during or after middle age; therefore it rarely occurs in children. Usually, older aged individuals are at the risk of developing chronic lymphocytic leukemia.

Our bodies makes blood stem cells; these are immature cells, that develop into mature blood cells over time. There are two types of blood stem cells; Myeloid stem cell and lymphoid stem cell.

The Myeloid stem cell can develop into one of three types of mature blood cells. These are:

• Red blood cells: these red blood cells carry oxygen and other materials to all tissues of the body.
• White blood cells: these fight infection and disease.
• Platelets: these help prevent bleeding by causing blood clots to form.

The lymphoid stem cell develops into a Lymphoblast cell and then into one of three types of lymphocytes or white blood cells. These are:

• B lymphocytes that make antibodies to help fight infection.
• T lymphocytes that help B lymphocytes make antibodies to fight infection and
• Natural killer cells that attack cancer cells and viruses.

In chronic Lymphocytic leukemia, too many of these blood stem cells develop into abnormal lymphatics and do not become healthy white blood cells. These abnormal cells may also be called leukemia cells. These lymphocytes are not able to help fight infection and this means that the number of lymphocytes grow stronger and become at a higher level in the blood and bone marrow, causing anemia, and sometimes easy bleeding.

About a month ago my Mom had cataract surgery. She complained about pain from the surgery, sticking in the eye and a lot of discomfort. This seemed unusual to us as most individuals we had known had little or no discomfort from this surgery. It was described as "a piece of cake" so to speak. We were not given the "what could happen," therefore we were at a loss as to why she was experiencing what others had not with the same surgery. We had even taken her back to the Ophthalmologist as instructed by the office who did the laser and he noticed nothing unusual.

On Friday after the surgery, the Doctor's office in Memphis called to she how she was progressing. We told him about her sympthoms and discomfort. They advised us to get her back to Memphis immediately. We were in Memphis by 4:30 p. m. and this started the process of a long night to say the least.

The Doctor at this examination was a Vitreoretinal Surgeon and she informed us that Mother needed surgery immediately. Her eye was highly infected and the infection was all in her eye, so she was admitted to the hospital for the surgery and possibly go home the next day.

Now, please know that Mother was not ignored by her family and I am not sure what the nursing home medical staff should have picked up on with her complaints; but didn't. We won't go there. My sister and I visit her almost every day. She lives in the nursing home which is five minutes from our house; we were aware of the discomfort but not to the extent of this vast infection. The nursing home makes their rounds and gives medication. They did not realize the extent of this infection as (she had a low grade fever only), nor did the Ophthalmologist that looked at the eye prior to Friday.

After admission to the hospital Mother was taken to surgery. After about one hour or more, one of the surgeons came to the room and informed us that Mother's white blood count was too high to perform the surgery until they knew exactly why the blood count was 38,000. At this point a General Practitioner and Oncologist/Hematologist had to get involved

They did and we were formed initially that it appeared to be Chronic Lymphocytic Leukemia. About a week later, it was confirmed.

Symptoms and Signs:

Sometimes and usually, CLL does not produce symptoms. Please remember that this is true initially and for chronic lymphocytic leukemia; when it is in the mild or early stage. Also note that this not "Acute Leukemia;" which is also a form of Leukemia/Cancer which has progressed much faster.

Even though in the early stages there may not be many symptoms other than tiredness for instance; a doctor should always be consulted if any of the following problems exist:

• painless swelling of the lymph nodes- in the neck, underarm, stomach or groin.
• feelings of extraordinary tiredness.
• pain or a fullness below the ribs.
• fever and infection.
• loss of weight for seemingly no reason.

 Mother does not know she has Chronic Lymphocytic Leukemia.  She is 89 and we feel that she might not have the quality of life that she has had up until now; if she knew.  Sometimes the words Leukemia and/or cancer gives a certain "death notice" which we do not want our Mother to experience.  This does not mean that we will never tell her; but it does mean that for now,  we wish for her to continue living life as she has for the previous 88 years and we feel it is in her best interest not to know.

She is in the beginning stages or at least in the "watchful waiting period."  We do not intend to put her through "chemo" at the present time.  Her physician agrees that for now; we will do the CBC more often, monitor her body signs, give her medication when necessary and give her all the love we have. 

 Test include:

• physical examination and a history for the patient this is to check for signs of the disease, such as lumps or anything that might be abnormal.
• complete blood count:  this (CBC) will give the number of red blood cells, white blood cells and platelets.  The amount of hemoglobin (the protein which carries oxygen) in the red blood cells and the portion of the blood sample made up of red blood cells.
• the CBC is used to monitor many different conditions and used for diagnosis.
• cytogenetic analysis:  this is a test where the blood or bone marrow is viewed under a microscope to look for changes in the structure or number of chromosomes in the lymphocytes.
• immunophenotyping:  this is a test used to determine if malignant lymphocytes (cancer) began from the B lymphocytes or the T lymphocytes.
• bone marrow aspiration and biopsy:  the removal of bone marrow, blood and a small piece of bone by inserting a hollow needle into the hipbone or breastbone.  A pathologist view the bone marrow, the blood and bone under a microscope to look for any abnormal cells.

Stages:

The treatment of course depends upon the stage. 

• Stage 0 - too many lymphocytes in the blood; with no other symptoms.
• Stage I -  too many lymphocytes in the blood and the lymph nodes are larger than normal.
• Stage II - too many lymphocytes in the blood, the liver or spleen is enlarged more than normal and the lymph nodes may be larger.
• Stage III - too many lymphocytes in the blood and too FEW red blood cells.  The lymp nodes, liver or spleen may be larger than what is preceived normal.
• Stage IV - too many lymphocytes in the blood and too few platelets.  The lymph nodes, liver or spleen may be larger than normal and there may be too few red blood cells.

The staging is done to find out how far the cancer has spread.  It is important to know the stage of this disease so that a plan may be made for the best treatment. 

Treatment:  * this does not include all therapy that is available but gives the beginning process and there are certain other test that are being tested in clinical trials.

• Watchful waiting- close monitoring of a patient's condition without giving any treatment until symptoms appear or change.  During this stage if there is infection; it is treated.
• Radiation therapy- a cancer treatment that is used to kill cancer cells or keep them from growing futher.  There is external radiation and internal radiation.
• Chemotherapy- this is a cancer treatment where drugs are used to stop the growth of cancer cells by killing the cells or by stopping them from dividing.  This can be taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells thoughout the body.

"Mother moved to heaven on December 14, 2011, and left us behind, but her memory will forever live and her prayers are what keeps us in line."

 The National Cancer Institute